Laserfiche WebLink
From: Franzen -Hill Inc. To: 12094683433 Page: 7/7 Date: 7/7/2011 11:14:46 AM <br />SWRCB, January 2006 <br />Spill Bucket Testing Report For <br />This forth is intended for arse by contractors perfor®rcing annual testing of UST spill containment structures+ The completed form and <br />printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br />1. FACILITY INFORMATION <br />Facility Name: Waterloo Liquors I Date of Testing: 6.30.11 <br />Facility Address: 2512 E. Waterloo Rd. - Stockton Ca. <br />Facility Contact: Heng Chea Phone: 209-463-4114 <br />Date Local Agency Was Notified of Testing: 6.27.11 <br />Name of Local Agency Inspector (Yfpresent during testing): San Joaaine Co. - Jeff Wona <br />' <br />CompanyName: Franzen -Hill <br />Technician Conducting Test: Jesse Vera HEE <br />Credentials': X CSLB Contractor X ICC Service Tech. D SWRCB Tank Tester 0 Other (Sped) 9563453702_ <br />License Number(s):. A304147 — 5259508 -UT <br />3. SPILL BUCKET TESTING INFORMATION <br />Test Method Used: X Hydrostatic 0 Vacuum 0 Other <br />Test Equipment Used: Equipment Resolution: .0 1 <br />Identify Spill Bucket (Sy Tank 1 87 2 91 3 Diesel <br />Number, Stored Product, etc. <br />Bucket Installation Type: X Direct Bury X Direct Bury X Direct Bury <br />0 Contained in Sump n Contained in Sump 0 Contained in Sum <br />Bucket Diameter: 13" <br />13" 13" <br />Bucket Depth: 17" <br />IT) 17" <br />Wait time between applying <br />15 min. <br />vacuum/water and start of test: <br />15 min. 15 min. <br />Test Start Time (Tr): 12:12pm. <br />10:00 am. 12:00 pin <br />Initial Reading (RO: 16" <br />16" 16" <br />Test End Time (Tr:): 1:12 pm. <br />11:00 am 1:00 pm. <br />Final Reading (RF): 16" <br />W' 161, <br />Test Duration (TF — TO: I hr. <br />I hr. I hr. <br />Change in Reading (RF - Itr): None <br />None None <br />Pass/Fail Threshold or <br />_ <br />Criteria: Pass <br />Pass Pass <br />Test Result: X Pass 0 Fail X Pass 0 Fail X Pass 0 Fail <br />Comments — )include information on repairs made,vrior to testinz; and recommended follow -urs for failed <br />test+) <br />CERTIFICATION OF Tl <br />I hereby certo that all the information <br />Technician's Signature: Jesse Vera / <br />►N R POI�SIBtLE FOR CONDUCTING THIS TESTING <br />RR, <br />repo its true, accurate, and Iii full compliance with legal requirements. <br />Date: 6.30.2011 <br />v <br />1 State laws and regulations do not currently r quire testing to be performed by a qualified contractor. However, local requirements <br />may ha rnnra QtrinaRnf <br />This fax was sent with GFI FAXmaker fax server. For more information, visit: http://www.gfi.com <br />